Urologic Trauma Management for Military Providers.

Autor:	Kronstedt S; Department of Urology, Baylor College of Medicine, Houston, TX 77030-3411, USA., Wahlstedt E; University of Kentucky School of Medicine, Lexington, KY 40506-0107, USA., Blacker M; NYU Grossman School of Medicine, New York, NY 10016-6402, USA., Saffati G; Department of Urology, Baylor College of Medicine, Houston, TX 77030-3411, USA., Hinojosa-Gonzalez DE; Department of Urology, Baylor College of Medicine, Houston, TX 77030-3411, USA., Wilbert H; Saint Louis University School of Medicine, Saint Louis, MO 63147-2912, USA., Fetherston T; Tripler Army Medical Center, Honolulu, HI 96819-1560, USA., Friedman J; Barnes Jewish Hospital, St. Louis, MO 63110-1003, USA., Mucher ZR; Houston Methodist Urology Associates, Houston, TX 77094-1521, USA.
Jazyk:	angličtina
Zdroj:	Military medicine [Mil Med] 2024 Jul 19. Date of Electronic Publication: 2024 Jul 19.
DOI:	10.1093/milmed/usae341
Abstrakt:	Introduction: Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. Materials and Methods: This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. Results: Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. Conclusions: In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries. (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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